2004 Legislation
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SENATE BILL NO. 1301 – Medical indgncy/nonnecessry service

SENATE BILL NO. 1301

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Bill Status



S1301aa...............................................by HEALTH AND WELFARE
MEDICAL INDIGENCY - Amends existing law relating to medical indigency to
revise procedures regarding the time and manner of filing application and
requirements for medical services with the clerk of a county; and to
include Medicaid copayments and deductibles as nonnecessary medical
services.
                                                                        
02/11    Senate intro - 1st rdg - to printing
02/12    Rpt prt - to Health/Wel
03/01    Rpt out - to 14th Ord
03/08    Rpt out amen - to engros
03/09    Rpt engros - 1st rdg - to 2nd rdg as amen
03/10    2nd rdg - to 3rd rdg as amen
03/11    3rd rdg as amen - PASSED - 33-1-1
      AYES -- Andreason(Andreason), Bailey, Brandt, Bunderson, Burtenshaw,
      Calabretta, Cameron, Compton, Darrington, Davis, Gannon, Goedde,
      Hill, Ingram, Kennedy, Keough, Little, Lodge, Malepeai, Marley,
      McKenzie, McWilliams, Noble, Noh, Pearce, Richardson, Schroeder,
      Sorensen, Stegner, Stennett, Sweet, Werk, Williams
      NAYS -- Burkett
      Absent and excused -- Geddes
    Floor Sponsor - Compton
    Title apvd - to House
03/11    House intro - 1st rdg - to Health/Wel
03/17    Rpt out - rec d/p - to 2nd rdg
03/18    2nd rdg - to 3rd rdg
03/19    3rd rdg - PASSED - 61-0-9
      AYES -- Andersen, Barraclough, Barrett, Bayer, Bell, Block, Boe,
      Bolz, Campbell, Cannon, Clark, Collins, Crow, Cuddy, Denney, Douglas,
      Eberle, Ellsworth, Eskridge, Field(18), Field(23), Gagner, Garrett,
      Harwood, Henbest, Jaquet, Jones, Kulczyk, Lake, Langford, Langhorst,
      Martinez, McGeachin, McKague, Meyer, Miller, Mitchell, Moyle,
      Naccarato, Nielsen, Pasley-Stuart, Raybould, Ridinger, Ring, Ringo,
      Robison, Rydalch, Sali, Sayler, Schaefer, Shepherd, Shirley, Skippen,
      Smith(30), Smith(24), Smylie, Snodgrass, Stevenson, Wills, Wood, Mr.
      Speaker
      NAYS -- None
      Absent and excused -- Bauer, Bedke, Black, Bradford, Deal, Edmunson,
      Kellogg, Roberts, Trail
    Floor Sponsor - Mitchell
    Title apvd - to Senate
03/19    To enrol
03/20    Rpt enrol - Pres signed - Sp signed
03/22    To Governor
03/24    Governor signed
         Session Law Chapter 300
         Effective: 07/01/04

Bill Text


                                                                        
                                                                        
  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-seventh Legislature                 Second Regular Session - 2004
                                                                        
                                                                        
                                       IN THE SENATE
                                                                        
                                    SENATE BILL NO. 1301
                                                                        
                              BY HEALTH AND WELFARE COMMITTEE
                                                                        
  1                                        AN ACT
  2    RELATING TO MEDICAL  INDIGENCY;  AMENDING  SECTION  31-3502,  IDAHO  CODE,  TO
  3        INCLUDE  MEDICAID  COPAYMENTS  AND  DEDUCTIBLES AS A NON-NECESSARY MEDICAL
  4        SERVICE; AMENDING  SECTION  31-3505,  IDAHO  CODE,  TO  REVISE  PROCEDURES
  5        REGARDING THE TIME AND MANNER OF FILING APPLICATION AND REQUESTS FOR MEDI-
  6        CAL  SERVICES  WITH  THE CLERK OF A COUNTY AND TO MAKE A TECHNICAL CORREC-
  7        TION; AND AMENDING SECTION 31-A3504, IDAHO CODE, TO CHANGE  THE  REFERENCE
  8        TO THE DEFINITION OF RESOURCES.
                                                                        
  9    Be It Enacted by the Legislature of the State of Idaho:
                                                                        
 10        SECTION  1.  That  Section 31-3502, Idaho Code, be, and the same is hereby
 11    amended to read as follows:
                                                                        
 12        31-3502.  DEFINITIONS. As used in this chapter, the terms defined in  this
 13    section shall have the following meaning, unless the context clearly indicates
 14    another meaning:
 15        (1)  "Medically  indigent"  means  any  person who is in need of necessary
 16    medical services and who, if an adult, together with his  or  her  spouse,  or
 17    whose parents or guardian if a minor, does not have income and other resources
 18    available  to him from whatever source sufficient to pay for necessary medical
 19    services. Nothing in this definition shall prevent the board of county commis-
 20    sioners and administrator from requiring the applicant and  obligated  persons
 21    to  reimburse the county and the catastrophic health care costs program, where
 22    appropriate, for all or a portion of their medical expenses,  when  investiga-
 23    tion  of  their application pursuant to this chapter, determines their ability
 24    to do so.
 25        (2)  "Hospital" means a facility licensed and regulated pursuant  to  sec-
 26    tions 39-1301 through 39-1314, Idaho Code, excluding state institutions.
 27        (3)  "Dependent" means any person whom a taxpayer could claim as a depend-
 28    ent under the income tax laws of the state of Idaho.
 29        (4)  "Applicant"  means  any  person who is or may be requesting financial
 30    assistance under this chapter.
 31        (5)  "Reimbursement rates" means the unadjusted  medicaid  rate  of  reim-
 32    bursement  for  medical  charges  allowed  pursuant to title XIX of the social
 33    security  act,  as   amended.   For   long-term   care   facilities,   maximum
 34    "reimbursement  rates"  means  the  unadjusted  medicaid rate of reimbursement
 35    allowed pursuant to the medical assistance program as determined by chapter 1,
 36    title 56, Idaho Code, or the unadjusted medicare rate of reimbursement  estab-
 37    lished  under title XVIII of the social security act, as amended, whichever is
 38    greater.
 39        (6)  "Board" means the board of county commissioners.
 40        (7)  "Obligated persons" means those persons who are  legally  responsible
 41    for an applicant.
 42        (8)  "County  hospital"  means any county approved institution or facility
 43    for the care of sick persons.
                                                                        
                                           2
                                                                        
  1        (9)  "Administrator" means the board of the catastrophic health care  cost
  2    program, as provided in section 31-3517, Idaho Code.
  3        (10) "Catastrophic health care costs" means all necessary medical expenses
  4    for  services  which  are  incurred by a recipient for which the reimbursement
  5    rate exceeds in aggregate the sum of ten thousand  dollars  ($10,000)  in  any
  6    twelve (12) consecutive month period.
  7        (11) "Recipient"  means  an  individual  determined eligible for necessary
  8    medical services under this chapter.
  9        (12) "Resident" means a person with a home, house, place of  abode,  place
 10    of habitation, dwelling or place where he or she actually lived for a consecu-
 11    tive  period of thirty (30) days or more within the state of Idaho. A resident
 12    does not include a person who comes into this state  for  temporary  purposes,
 13    including,  but  not limited to, education, vacation, or seasonal labor. Entry
 14    into active military duty shall not change a person's residence for  the  pur-
 15    poses  of  this chapter. Those physically present within the following facili-
 16    ties and institutions shall be residents of the county where they  were  resi-
 17    dents prior to entering the facility or institution:
 18        (a)  Correctional facilities;
 19        (b)  Nursing homes or residential or assisted living facilities;
 20        (c)  Other medical facility or institution.
 21        (13) "Emergency  service" means a service provided for a medical condition
 22    in which sudden, serious and unexpected symptoms of illness or injury are suf-
 23    ficiently severe to necessitate or call for immediate medical care.
 24        (14) "Provider" means  any  person,  firm,  or  corporation  certified  or
 25    licensed  by the state of Idaho or holding an equivalent license or certifica-
 26    tion in another state, that provides necessary medical services as it  appears
 27    on an application for assistance pursuant to this chapter.
 28        (15) "Third party applicant" means a person other than an obligated person
 29    who completes, signs and files an application on behalf of a patient.
 30        (16) "Clerk" means the clerk of the board or his or her designee.
 31        (17) "Resources"  means all property, whether tangible or intangible, real
 32    or personal, liquid or nonliquid, including, but not limited to, all forms  of
 33    public  assistance,  crime  victim's compensation, worker's compensation, vet-
 34    erans benefits, medicaid, medicare and any other property from any source  for
 35    which  an  applicant and/or an obligated person may be eligible or in which he
 36    or she may have an interest. Resources shall include the ability of an  appli-
 37    cant and obligated persons to pay for necessary medical services over a period
 38    of  up  to  three  (3) years. For purposes of determining approval for medical
 39    indigency only, resources shall not include the value of the homestead on  the
 40    applicant  or obligated persons' residence, a burial plot, exemptions for per-
 41    sonal property allowed in section 11-605(1) through (3), Idaho Code, and addi-
 42    tional exemptions allowed by county resolution.
 43        (18)  A. "Necessary medical services" means a requested or provided  medi-
 44        cal  service  required  in order to identify or treat a medically indigent
 45        person's health condition, illness or injury and is:
 46             (a)  Consistent with the symptoms, diagnosis or treatment of the med-
 47             ical indigent's condition, illness or injury;
 48             (b)  In accordance with generally accepted standards  of  medical  or
 49             surgical practice then prevailing in the community where the services
 50             were provided;
 51             (c)  Furnished  on an outpatient basis whenever it is safe, efficient
 52             and reasonable to do so;
 53             (d)  Not provided primarily for  the  convenience  of  the  medically
 54             indigent person or the provider;
 55             (e)  The  standard,  most economical service or item that can safely,
                                                                        
                                           3
                                                                        
  1             reasonably and ethically be provided.
  2        B.  Necessary medical services shall not include the following:
  3             (a)  Bone marrow transplants;
  4             (b)  Organ transplants;
  5             (c)  Elective, cosmetic and/or experimental procedures;
  6             (d)  Services related to, or provided by, residential and/or  shelter
  7             care facilities;
  8             (e)  Normal,  uncomplicated pregnancies, excluding caesarean section,
  9             and childbirth well-baby care;
 10             (f)  Medicare copayments and deductibles; and
 11             (g)  Services provided by, or available to an applicant  from  state,
 12             federal and local health programs; and
 13             (h)  Medicaid copayments and deductibles.
 14        Provided  however,  each  board  may determine, by ordinance or resolution
 15    duly adopted in its county, to include as  necessary  medical  services  addi-
 16    tional  services  not covered in this section. Necessary medical services pro-
 17    vided by this option shall not be paid by the catastrophic health  care  costs
 18    program, and shall remain the liability of the respective county.
                                                                        
 19        SECTION  2.  That  Section 31-3505, Idaho Code, be, and the same is hereby
 20    amended to read as follows:
                                                                        
 21        31-3505.  TIME AND MANNER OF FILING APPLICATIONS  AND  REQUESTS.  Applica-
 22    tions  and  requests  for  necessary  medical services shall be filed with the
 23    clerk according to the following time limits. Filing is complete upon  receipt
 24    by the clerk.
 25        (1)  An  application  for nonemergency necessary medical services shall be
 26    filed ten (10) days prior to receiving services from the provider.
 27        (2)  An application for emergency necessary medical services shall be made
 28    any time within thirty-one (31) days beginning with the first day of the  pro-
 29    vision  of necessary medical services from the provider or in the case of hos-
 30    pitalization, thirty-one (31) days beginning with the date of admission.
 31        (3)  Requests for additional treatment related to an original diagnosis in
 32    accordance with a preapproved treatment plan shall  be  filed  ten  (10)  days
 33    prior to receiving services.
 34        (4)  (a) A delayed application for necessary medical services may be filed
 35    up to one hundred eighty (180) days beginning with the first day of the provi-
 36    sion of necessary medical services on condition provided that:
 37        (a)  Written  documentation  is  included with the application showing the
 38        provider and/or applicant demonstrates that an bona  fide  application  or
 39        claim  has been filed for social security disability insurance, supplemen-
 40        tal security income, third party insurance, medicaid, medicare, crime vic-
 41        tim's compensation, and/or worker's compensation. A bona fide  application
 42        means that:
 43             (i)   The application was timely filed within ninety (90) days begin-
 44             ning  with  the  first day of the provision of necessary medical ser-
 45             vices from the provider or, in the case  of  hospitalization,  ninety
 46             (90)  days  beginning  with  the  date  of admission. the appropriate
 47             agency's application or claim time period; and
 48             (ii)  Given the circumstances of the patient  and/or  obligated  per-
 49             sons,  the  patient  and/or  obligated  persons  would  reasonably be
 50             expected to meet the eligibility criteria for such resources; and
 51             (iii) The application was filed with the appropriate agency in such a
 52             time and manner that, if approved, it would provide for payment  cov-
 53             erage of all the bills included in the county application; and
                                                                        
                                           4
                                                                        
  1             (iv)  In  the event an application is filed for supplemental security
  2             income, an Idaho medicaid  application  must  also  have  been  filed
  3             within  the  department  of health and welfare's application or claim
  4             time period to provide payment coverage of eligible bills included in
  5             the county application.
  6        (b)  Failure by the patient  and/or  obligated  persons  to  complete  the
  7        application  process  described  in  this section, up to and including any
  8        reasonable appeal of any denial of benefits, with the  applicable  program
  9        noted  in  paragraph (a) of this subsection, shall result in denial of the
 10        county assistance application.
 11        (5)  Any application or request which fails to meet the provisions of this
 12    section, and/or other provisions of this chapter, shall be denied.
 13        (6)  In the event that a county determines that a different county is  the
 14    obligated  county,  an  application  may  be  filed in the other county within
 15    thirty (30) days of the date of the initial county denial.
                                                                        
 16        SECTION 3.  That Section 31-A3504, Idaho Code, be, and the same is  hereby
 17    amended to read as follows:
                                                                        
 18        31-A3504.  ADVISORY  DECISIONS OF PANEL. The general responsibility of the
 19    advisory panel will be to consider the eligibility  of  applicants  on  claims
 20    referred  to  them  and  render written opinions regarding such eligibility of
 21    applicants as based upon review of analysis of the resources available to  the
 22    applicant, as defined in the Uniform County Guidelines on Indigent Eligibility
 23    referred to in section 31-3503 section 31-3502(17), Idaho Code. Following pro-
 24    ceedings  on each claim, the advisory panel shall provide the affected parties
 25    with its comments and observations with respect to the claim. They shall indi-
 26    cate in such comments whether the applicant appears to have  resources  avail-
 27    able  to him or her sufficient to pay for necessary medical services; does not
 28    have adequate resources; or any comments or observations which may be relevant
 29    and appropriate. The findings of the advisory panel may be  used  by  affected
 30    parties in resolving contested claims in a manner consistent with the findings
 31    presented.  However,  such  findings  will  be advisory in nature only and not
 32    binding on any of the affected parties.

Amendment


                                                                        
                                                                        
  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-seventh Legislature                 Second Regular Session - 2004
                                                                        
                                                                        
                                                     Moved by    Compton             
                                                                        
                                                     Seconded by Brandt              
                                                                        
                                                                        
                                       IN THE SENATE
                             SENATE AMENDMENT TO S.B. NO. 1301
                                                                        
  1                               AMENDMENTS TO SECTION 2
  2        On page 3 of  the  printed  bill,  in  line  37,  following  "application"
  3    insert:  "or  no later than forty-five (45) days after an application has been
  4    filed"; in line 49, following "obligated persons" insert:  ",  and  given  the
  5    information available at the time the application or claim for other resources
  6    is  filed,"; in line 53, following "erage of" delete "all"; following line 53,
  7    insert:
  8        "(iv)  In the discretion of the board,  bills  on  a  delayed  application
  9        which  would  not  have been covered by a successful application or timely
 10        claim to the other resource(s) may be denied by  the  board  as  untimely;
 11        and";
 12    and on page 4, in line 1, delete "(iv)" and insert: "(v)".

Engrossed Bill (Original Bill with Amendment(s) Incorporated)


                                                                        
                                                                        
  ]]]]              LEGISLATURE OF THE STATE OF IDAHO             ]]]]
 Fifty-seventh Legislature                 Second Regular Session - 2004
                                                                        
                                                                        
                                       IN THE SENATE
                                                                        
                              SENATE BILL NO. 1301, As Amended
                                                                        
                              BY HEALTH AND WELFARE COMMITTEE
                                                                        
  1                                        AN ACT
  2    RELATING TO MEDICAL  INDIGENCY;  AMENDING  SECTION  31-3502,  IDAHO  CODE,  TO
  3        INCLUDE  MEDICAID  COPAYMENTS  AND  DEDUCTIBLES AS A NON-NECESSARY MEDICAL
  4        SERVICE; AMENDING  SECTION  31-3505,  IDAHO  CODE,  TO  REVISE  PROCEDURES
  5        REGARDING THE TIME AND MANNER OF FILING APPLICATION AND REQUESTS FOR MEDI-
  6        CAL  SERVICES  WITH  THE CLERK OF A COUNTY AND TO MAKE A TECHNICAL CORREC-
  7        TION; AND AMENDING SECTION 31-A3504, IDAHO CODE, TO CHANGE  THE  REFERENCE
  8        TO THE DEFINITION OF RESOURCES.
                                                                        
  9    Be It Enacted by the Legislature of the State of Idaho:
                                                                        
 10        SECTION  1.  That  Section 31-3502, Idaho Code, be, and the same is hereby
 11    amended to read as follows:
                                                                        
 12        31-3502.  DEFINITIONS. As used in this chapter, the terms defined in  this
 13    section shall have the following meaning, unless the context clearly indicates
 14    another meaning:
 15        (1)  "Medically  indigent"  means  any  person who is in need of necessary
 16    medical services and who, if an adult, together with his  or  her  spouse,  or
 17    whose parents or guardian if a minor, does not have income and other resources
 18    available  to him from whatever source sufficient to pay for necessary medical
 19    services. Nothing in this definition shall prevent the board of county commis-
 20    sioners and administrator from requiring the applicant and  obligated  persons
 21    to  reimburse the county and the catastrophic health care costs program, where
 22    appropriate, for all or a portion of their medical expenses,  when  investiga-
 23    tion  of  their application pursuant to this chapter, determines their ability
 24    to do so.
 25        (2)  "Hospital" means a facility licensed and regulated pursuant  to  sec-
 26    tions 39-1301 through 39-1314, Idaho Code, excluding state institutions.
 27        (3)  "Dependent" means any person whom a taxpayer could claim as a depend-
 28    ent under the income tax laws of the state of Idaho.
 29        (4)  "Applicant"  means  any  person who is or may be requesting financial
 30    assistance under this chapter.
 31        (5)  "Reimbursement rates" means the unadjusted  medicaid  rate  of  reim-
 32    bursement  for  medical  charges  allowed  pursuant to title XIX of the social
 33    security  act,  as   amended.   For   long-term   care   facilities,   maximum
 34    "reimbursement  rates"  means  the  unadjusted  medicaid rate of reimbursement
 35    allowed pursuant to the medical assistance program as determined by chapter 1,
 36    title 56, Idaho Code, or the unadjusted medicare rate of reimbursement  estab-
 37    lished  under title XVIII of the social security act, as amended, whichever is
 38    greater.
 39        (6)  "Board" means the board of county commissioners.
 40        (7)  "Obligated persons" means those persons who are  legally  responsible
 41    for an applicant.
 42        (8)  "County  hospital"  means any county approved institution or facility
 43    for the care of sick persons.
                                                                        
                                           2
                                                                        
  1        (9)  "Administrator" means the board of the catastrophic health care  cost
  2    program, as provided in section 31-3517, Idaho Code.
  3        (10) "Catastrophic health care costs" means all necessary medical expenses
  4    for  services  which  are  incurred by a recipient for which the reimbursement
  5    rate exceeds in aggregate the sum of ten thousand  dollars  ($10,000)  in  any
  6    twelve (12) consecutive month period.
  7        (11) "Recipient"  means  an  individual  determined eligible for necessary
  8    medical services under this chapter.
  9        (12) "Resident" means a person with a home, house, place of  abode,  place
 10    of habitation, dwelling or place where he or she actually lived for a consecu-
 11    tive  period of thirty (30) days or more within the state of Idaho. A resident
 12    does not include a person who comes into this state  for  temporary  purposes,
 13    including,  but  not limited to, education, vacation, or seasonal labor. Entry
 14    into active military duty shall not change a person's residence for  the  pur-
 15    poses  of  this chapter. Those physically present within the following facili-
 16    ties and institutions shall be residents of the county where they  were  resi-
 17    dents prior to entering the facility or institution:
 18        (a)  Correctional facilities;
 19        (b)  Nursing homes or residential or assisted living facilities;
 20        (c)  Other medical facility or institution.
 21        (13) "Emergency  service" means a service provided for a medical condition
 22    in which sudden, serious and unexpected symptoms of illness or injury are suf-
 23    ficiently severe to necessitate or call for immediate medical care.
 24        (14) "Provider" means  any  person,  firm,  or  corporation  certified  or
 25    licensed  by the state of Idaho or holding an equivalent license or certifica-
 26    tion in another state, that provides necessary medical services as it  appears
 27    on an application for assistance pursuant to this chapter.
 28        (15) "Third party applicant" means a person other than an obligated person
 29    who completes, signs and files an application on behalf of a patient.
 30        (16) "Clerk" means the clerk of the board or his or her designee.
 31        (17) "Resources"  means all property, whether tangible or intangible, real
 32    or personal, liquid or nonliquid, including, but not limited to, all forms  of
 33    public  assistance,  crime  victim's compensation, worker's compensation, vet-
 34    erans benefits, medicaid, medicare and any other property from any source  for
 35    which  an  applicant and/or an obligated person may be eligible or in which he
 36    or she may have an interest. Resources shall include the ability of an  appli-
 37    cant and obligated persons to pay for necessary medical services over a period
 38    of  up  to  three  (3) years. For purposes of determining approval for medical
 39    indigency only, resources shall not include the value of the homestead on  the
 40    applicant  or obligated persons' residence, a burial plot, exemptions for per-
 41    sonal property allowed in section 11-605(1) through (3), Idaho Code, and addi-
 42    tional exemptions allowed by county resolution.
 43        (18)  A. "Necessary medical services" means a requested or provided  medi-
 44        cal  service  required  in order to identify or treat a medically indigent
 45        person's health condition, illness or injury and is:
 46             (a)  Consistent with the symptoms, diagnosis or treatment of the med-
 47             ical indigent's condition, illness or injury;
 48             (b)  In accordance with generally accepted standards  of  medical  or
 49             surgical practice then prevailing in the community where the services
 50             were provided;
 51             (c)  Furnished  on an outpatient basis whenever it is safe, efficient
 52             and reasonable to do so;
 53             (d)  Not provided primarily for  the  convenience  of  the  medically
 54             indigent person or the provider;
 55             (e)  The  standard,  most economical service or item that can safely,
                                                                        
                                           3
                                                                        
  1             reasonably and ethically be provided.
  2        B.  Necessary medical services shall not include the following:
  3             (a)  Bone marrow transplants;
  4             (b)  Organ transplants;
  5             (c)  Elective, cosmetic and/or experimental procedures;
  6             (d)  Services related to, or provided by, residential and/or  shelter
  7             care facilities;
  8             (e)  Normal,  uncomplicated pregnancies, excluding caesarean section,
  9             and childbirth well-baby care;
 10             (f)  Medicare copayments and deductibles; and
 11             (g)  Services provided by, or available to an applicant  from  state,
 12             federal and local health programs; and
 13             (h)  Medicaid copayments and deductibles.
 14        Provided  however,  each  board  may determine, by ordinance or resolution
 15    duly adopted in its county, to include as  necessary  medical  services  addi-
 16    tional  services  not covered in this section. Necessary medical services pro-
 17    vided by this option shall not be paid by the catastrophic health  care  costs
 18    program, and shall remain the liability of the respective county.
                                                                        
 19        SECTION  2.  That  Section 31-3505, Idaho Code, be, and the same is hereby
 20    amended to read as follows:
                                                                        
 21        31-3505.  TIME AND MANNER OF FILING APPLICATIONS  AND  REQUESTS.  Applica-
 22    tions  and  requests  for  necessary  medical services shall be filed with the
 23    clerk according to the following time limits. Filing is complete upon  receipt
 24    by the clerk.
 25        (1)  An  application  for nonemergency necessary medical services shall be
 26    filed ten (10) days prior to receiving services from the provider.
 27        (2)  An application for emergency necessary medical services shall be made
 28    any time within thirty-one (31) days beginning with the first day of the  pro-
 29    vision  of necessary medical services from the provider or in the case of hos-
 30    pitalization, thirty-one (31) days beginning with the date of admission.
 31        (3)  Requests for additional treatment related to an original diagnosis in
 32    accordance with a preapproved treatment plan shall  be  filed  ten  (10)  days
 33    prior to receiving services.
 34        (4)  (a) A delayed application for necessary medical services may be filed
 35    up to one hundred eighty (180) days beginning with the first day of the provi-
 36    sion of necessary medical services on condition provided that:
 37        (a)  Written  documentation  is  included with the application or no later
 38        than forty-five (45) days after an application has been filed showing  the
 39        provider  and/or  applicant  demonstrates that an bona fide application or
 40        claim has been filed for social security disability insurance,  supplemen-
 41        tal security income, third party insurance, medicaid, medicare, crime vic-
 42        tim's  compensation, and/or worker's compensation. A bona fide application
 43        means that:
 44             (i)   The application was timely filed within ninety (90) days begin-
 45             ning with the first day of the provision of  necessary  medical  ser-
 46             vices  from  the  provider or, in the case of hospitalization, ninety
 47             (90) days beginning with  the  date  of  admission.  the  appropriate
 48             agency's application or claim time period; and
 49             (ii)  Given  the  circumstances  of the patient and/or obligated per-
 50             sons, the patient and/or obligated persons, and given the information
 51             available at the time the application or claim for other resources is
 52             filed, would reasonably be expected to meet the eligibility  criteria
 53             for such resources; and
                                                                        
                                           4
                                                                        
  1             (iii) The application was filed with the appropriate agency in such a
  2             time  and manner that, if approved, it would provide for payment cov-
  3             erage of the bills included in the county application; and
  4             (iv)  In the discretion of the board, bills on a delayed  application
  5             which  would  not  have  been  covered by a successful application or
  6             timely claim to the other resource(s) may be denied by the  board  as
  7             untimely; and
  8             (v)  In  the  event an application is filed for supplemental security
  9             income, an Idaho medicaid  application  must  also  have  been  filed
 10             within  the  department  of health and welfare's application or claim
 11             time period to provide payment coverage of eligible bills included in
 12             the county application.
 13        (b)  Failure by the patient  and/or  obligated  persons  to  complete  the
 14        application  process  described  in  this section, up to and including any
 15        reasonable appeal of any denial of benefits, with the  applicable  program
 16        noted  in  paragraph (a) of this subsection, shall result in denial of the
 17        county assistance application.
 18        (5)  Any application or request which fails to meet the provisions of this
 19    section, and/or other provisions of this chapter, shall be denied.
 20        (6)  In the event that a county determines that a different county is  the
 21    obligated  county,  an  application  may  be  filed in the other county within
 22    thirty (30) days of the date of the initial county denial.
                                                                        
 23        SECTION 3.  That Section 31-A3504, Idaho Code, be, and the same is  hereby
 24    amended to read as follows:
                                                                        
 25        31-A3504.  ADVISORY  DECISIONS OF PANEL. The general responsibility of the
 26    advisory panel will be to consider the eligibility  of  applicants  on  claims
 27    referred  to  them  and  render written opinions regarding such eligibility of
 28    applicants as based upon review of analysis of the resources available to  the
 29    applicant, as defined in the Uniform County Guidelines on Indigent Eligibility
 30    referred to in section 31-3503 section 31-3502(17), Idaho Code. Following pro-
 31    ceedings  on each claim, the advisory panel shall provide the affected parties
 32    with its comments and observations with respect to the claim. They shall indi-
 33    cate in such comments whether the applicant appears to have  resources  avail-
 34    able  to him or her sufficient to pay for necessary medical services; does not
 35    have adequate resources; or any comments or observations which may be relevant
 36    and appropriate. The findings of the advisory panel may be  used  by  affected
 37    parties in resolving contested claims in a manner consistent with the findings
 38    presented.  However,  such  findings  will  be advisory in nature only and not
 39    binding on any of the affected parties.

Statement of Purpose / Fiscal Impact


                        STATEMENT OF PURPOSE
                              RS 13838

The purpose of this legislation is to provide guidelines that clearly 
state when, how and who should be considered when filing a delayed 
application for medically indigent assistance. The original intent of 
the 180 day delayed application process was to encourage providers to
pursue other legitimate avenues of payment before filing an application 
for county medical indigent assistance, so that fewer applications would 
be received requesting taxpayer assistance with an indigent's medical 
bills. This has worked well when the spirit as well as the law has been
properly followed. In some areas of the State the purpose of the existing
 law has been thwarted by those who have begun using the delayed 
application process as a method of obtaining more time to file a request 
for assistance. When this occurs the indigent has sometimes dissipated 
assets that could have provided reimbursement to the property taxpayers 
for the assistance provided. Reliance on the property taxpayers should 
remain a last resort. This technical correction seeks to close the 
loophole in the process being exploited in some parts of the State
while still meeting the original intent of the legislature to allow 
a delayed application to be filed when there is a demonstrated active 
pursuit of other sources of payment before a request for assistance 
from the property taxpayers is made.  

                            FISCAL IMPACT

There is no fiscal impact on the State of Idaho or any political 
subdivision.


CONTACT: Idaho Association of Counties            Phone: 345-9126

Dan Chadwick        Tony Poinelli
Maggie Mahoney      Kerry Ellen Elliott




STATEMENT OF PURPOSE/FISCAL IMPACT                    S 1301